Black Book Market Research's 2013 ranking of e-prescribing systems predicts substantial growth in 2013, propelled by federal government and commercial health insurance. The use of e-prescribing has grown from 6% of physicians using these systems in 2007 to 65% in 2012, and, as penalties approach, Black Book estimates more physicians will jump on the e-prescribing bandwagon to earn incentive money and achieve Meaningful Use.

"There seems to be an onslaught of clinicians trying to get implementation done in time for Meaningful Use," said Doug Brown, managing partner at Black Book, in an interview with InformationWeek Healthcare. "People were stretched thin with everything, dissatisfaction was there, and some couldn't get a system implemented. According to what we can tell from surveying users, they're spending time looking at vendors because they're having trepidation of not meeting Meaningful Use."

Black Book ranked overall e-prescribing client satisfaction scores for a number of systems and broke down its findings into five categories: Best electronic health record (EHR)/standalone e-RX product partnership; best standalone e-RX; best EHR-based integrated e-RX module; best "meaningful user" for stage 1 and stage 2 achievement; and best system for interoperability, connectivity and achievement. Practice Fusion took home the top prize for best system for Meaningful Use and EHR-based integrated module, while DrFirst earned the highest satisfaction scores as the best standalone e-RX system, and for its partnership with Greenway Medical. Finally, Emdeon earned the highest satisfaction rates for interoperability, connectivity and achievement.

Brown said some of the findings were expected. For example, DrFirst has seen consistently high scores "since they've been around for a while and had clients using their system before EHRs; folks were just on their e-RX system," he said. "As Meaningful Use became more of an initiative for physician offices, they were already comfortable with DrFirst…[T]hose companies experience higher user satisfaction because it makes it simple to implement an [electronic medical record] on top of their e-RX system."

Practice Fusion experienced similar results. "Their EHR had been around for a long time and always had consistent, high satisfaction scores," Brown said. "They have the least rankings that show disruption or contemplating change by clients. For instance, some [clients] show dissatisfaction with an e-RX and their EMR as this point. Next year, we're going to see some changes being made."

Given physicians' concern with meeting Meaningful Use requirements, Black Book also ranked the top 10 systems for achieving MU by measuring clients "on track" for achieving both Stage 1 and Stage 2 based on their vendor of choice. Practice Fusion topped the list, followed by Athenahealth, SRS Soft and Vitera.

Brown noted an interesting trend in e-RX adoption and meeting Meaningful Use requirements. "There is some vendor flux going on, particularly with facility-based EMRs," he said. "Those who put financial investments into purchasing an e-RX system aren't seeing the support they expect as far as staff education, customization, those kinds of issues." As a result, Brown said Black Book is seeing 40% of clients who have a facility-based program expecting to increase their budget to address these issues or change to another system to help meet Meaningful Use requirements. "Sixty percent across the board, clients were happy with systems, but 40% of facility-based systems are anticipating some sort of flux with vendors," he said.

Although significant growth is expected in the year ahead, the report outlined several challenges that will still persist with the implementation of e-prescribing systems. Funding is a top concern for providers. "All physicians, but particularly those in small practices, the inner city or in rural settings, may believe that the cost of a system is too high for them to ever receive a positive return on investment," the report said.

In addition, connectivity poses problems. Although almost all chain pharmacies -- 97% -- are connected to the e-prescribing system, a vast majority of independent pharmacies are not. State regulations also can create challenges with their variations in who may prescribe, what may be prescribed and under what circumstances.

"Reconciliation of those laws and requirements is important because many Americans live in one state and may obtain healthcare in another," the report read. "State governments … need to conduct their own analysis of laws and regulations within their own states so as to update to accommodate e-prescribing, [like] reconciling paper documentation requirements with electronic data storage, [and] facilitate e-prescribing and other health information exchange across state lines."

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